Healthcare Provider Details

I. General information

NPI: 1992979181
Provider Name (Legal Business Name): DERMOTT FAMILY PRACTICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N FREEMAN ST
DERMOTT AR
71638-2304
US

IV. Provider business mailing address

PO BOX 227
DERMOTT AR
71638-0227
US

V. Phone/Fax

Practice location:
  • Phone: 870-538-3800
  • Fax:
Mailing address:
  • Phone: 870-538-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE-3872
License Number StateAR

VIII. Authorized Official

Name: DR. CAROLYN E. VOGLER
Title or Position: PRESIDENT
Credential: MEDICAL DOCTOR
Phone: 870-538-3800